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    Changing Trends in The Treatment of Mandibular Fracture: Mohammad Waheed El-Anwar

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    Changing Trends in The Treatment of Mandibular Fracture: Mohammad Waheed El-Anwar

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    Changing Trends in The Treatment of Mandibular Fracture: Mohammad Waheed El-Anwar

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    of 2

    THIEME

    Letter to the Editor 195

    Changing Trends in the Treatment of Mandibular


    Fracture
    Mohammad Waheed El-Anwar1

    1 Deparment of Otorhinolaryngology Head and Neck Surgery, Address for correspondence Mohammad Waheed El-Anwar, MD,
    Faculty of Medicine, Zagazig University, Zagazig, Egypt Deparment of Otorhinolaryngology Head and Neck Surgery, Faculty of
    Medicine, Zagazig University, Zagazig 0020552309843, Egypt
    Int Arch Otorhinolaryngol 2018;22:195–196. (e-mail: [email protected]; [email protected]).

    Excluding nasal fractures, mandibular fractures are the most Immediate postoperative release of the rigid MMF after
    common fractures of the facial bones. A functioning intact OR/IF using titanium miniplate(s) was confirmed to be as
    mandible is essential for biting, chewing and speaking.1 effective and safe as maintaining postoperative rigid MMF for
    The first description of a mandibular fracture dates back different durations.5,6 However, the use of rigid intraopera-
    to 1650 BC, and an Egyptian papyrus describes the exam- tive MMF increases the operative time, cost, blood-trans-
    ination, diagnosis and treatment of mandibular fractures. mitted diseases to patients and/or the surgical team and the
    Hippocrates was the first to mention the reapproximation risk of tooth injury. These factors opened the door for recent
    and immobilization of the fractured mandible utilizing studies searching for simpler, faster, easier and at the same
    circumdental wires and external bandaging. The impor- time effective OR/IF of the fractured mandible.4
    tance of first establishing proper dental occlusion was After a prospective comparative study, El-Anwar et al4
    highlighted in the textbook written by Roger of Salerno in found that manual MMF (3MF) during the OR/IF of selected
    Italy in 1180. Rigid maxillomandibular fixation (MMF) was cases of mandibular fractures could be successfully per-
    first mentioned in 1492, in an edition of the book Cirugia, formed, allowing for a more rapid and less complex pro-
    which was printed in Lyons, France. Moreover, rigid internal cedure limited to the mandible. In addition to the gained
    fixation was developed and popularized by Spiessel in benefits of immediate postoperative mandible mobiliza-
    Europe in 1970s.2,3 tion, 3MF provided significantly shorter operative times
    The purposes of the treatment of mandibular fractures are (p < 0001), less risk of blood-transmitted diseases to the
    to restore the pre-trauma dental occlusion and normal surgical team and the patient, and significantly better early
    mouth opening and to reduce the displaced fracture.4 mouth opening (p ¼ 0.0015).
    Open reduction/internal fixation (OR/IF) has dramatically In a later study of the the advantages of the rapid 3MF
    revolutionized the approach to mandible fractures, mini- procedure that is limited to the mandible, El-Anwar and
    mizing the postoperative role of rigid MMF. But MMF is still Hegab9 were the first to investigate the 3MF repair of
    used to maintain proper occlusion until the IF of the fracture fractured mandibles under regional anesthesia comparing
    is performed.4–6 the results with a control group in which 3MF was performed
    Traditionally, closed reduction and OR/IF using wire under general anesthesia (GA). They used an extraoral man-
    osteosynthesis require an average of 6 weeks of immobili- dibular nerve block, and concluded that regional anesthesia
    zation by MMF in order to achieve satisfactory healing. can replace GA in the OR/IF of selected cases of mandibular
    Negative sequelae associated with this extended period of fracture (parasymphyseal fracture) without reported com-
    immobilization include airway problems, poor nutrition, plications, providing an optimal solution when GA is not
    weight loss, poor oral hygiene, speech difficulties, social recommended or contraindicated.
    inconvenience, insomnia, patient discomfort, work difficul- More studies applying regional anesthesia in other types
    ties, and difficulty in retrieving the normal opening range of of mandibular fracture are expected to be conducted in the
    the jaw. In contrast, rigid and semirigid fixation of the near future. The maxillofacial surgeons’ awareness of those
    mandible fractures enables early mobilization and restora- easier and reliable alternatives needs to be increased so these
    tion of normal jaw mobility, improved nutritional status, simpler and effective repairs become more popular.
    improved speech and oral hygiene, patient comfort and an When there is a need to maintain a postoperative rigid
    early return to work.7,8 MMF, various methods have been employed over time. Even

    received DOI https://doi.org/ Copyright © 2018 by Thieme Revinter


    April 5, 2017 10.1055/s-0037-1606645. Publicações Ltda, Rio de Janeiro, Brazil
    accepted ISSN 1809-9777.
    August 24, 2017
    published online
    October 25, 2017
    196 Letter to the Editor

    though arch bars are effective for rigid MMF, they are not References
    devoid of negative aspects. Intermaxillary fixation (IMF) 1 Kumar I, Singh V, Bhagol A, Goel M, Gandhi S. Supplemental

    screws are similarly effective for rigid MMF regarding post- maxillomandibular fixation with miniplate osteosynthesis-re-
    quired or not? Oral Maxillofac Surg 2011;15(01):27–30
    operative occlusion and MMF stability. Additionally, IMF
    2 Spiessl B. Rigid internal fixation of fractures of the lower jaw.
    screws have the advantages of decreasing the surgical time Reconstr Surg Traumatol 1972;13:124–140
    and gloves perforations, and of enabling better patient 3 Ellis E III, Miles BA. Fractures of the mandible: a technical
    acceptance and oral hygiene. Accidental root perforation is perspective. Plast Reconstr Surg 2007;120(07, Suppl 2):76S–89S
    the only limitation to IMF screws.10 4 El-Anwar MW, Sayed El-Ahl MA, Amer HS. Open reduction and
    The treatment of mandibular angle fractures represents a internal fixation of mandibular fracture without rigid maxilloman-
    dibular fixation. Int Arch Otorhinolaryngol 2015;19(04):314–318
    challenge due to their higher rate of complications, and there is
    5 Gupta R, Surayana S, Pandya VK, et al. Traumatic mandibular
    currently no agreement as to the optimal treatment. The fractures: Pendulum swinging towards closed reduction? World
    percutaneous approach using the transbuccal trocar technique Articles of Ear, Nose, and Throat 2010;3:1
    provides easy access and fixation of the screws. Recently, El- 6 Haug RH, Assael LA. Outcomes of open versus closed treatment of
    Anwar and Sweed11 described a new, effective and simple mandibular subcondylar fractures. J Oral Maxillofac Surg 2001;59
    percutaneous transbuccal approach using a modified cover of (04):370–375, discussion 375–376
    7 Singh B, Bhardwaj V. Continuous mandibular nerve block for pain
    the cannula as a disposable available trocar for the admission
    relief. A report of two cases. Can J Anaesth 2002;49(09):951–953
    and conduction of a microdrill shaft and screw driver directly 8 Nacamuli RP, Longaker MT. Bone induction in craniofacial defects.
    to the fracture. Orthod Craniofac Res 2005;8(04):259–266
    The familiarity with and popularity of these simpler effec- 9 El-Anwar MW, Hegab A. Internal fixation of single mandibular
    tive trends in mandibular fracture repair will be very beneficial fracture under mandibular nerve block. Oral Maxillofac Surg
    2016;20(01):57–61
    for surgeons, patients and the community in general.
    10 Qureshi AA, Reddy UK, Warad NM, Badal S, Jamadar AA, Qurishi N.
    Intermaxillary fixation screws versus Erich arch bars in mandib-
    Financial Support ular fractures: A comparative study and review of literature. Ann
    The author received no financial support to write this letter. Maxillofac Surg 2016;6(01):25–30
    11 El-Anwar MW, Sweed AH. Simple percutaneous transbuccal
    Conflicts of Interest approach for management of mandibular angular fracture.
    J Craniofac Surg 2017;28(04):1035–1037
    The author has no conflicts of interest to disclose.

    International Archives of Otorhinolaryngology Vol. 22 No. 3/2018

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